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Where to get help •The emergency department of your nearest hospital •Paediatrician •Primary care physician There are several questions that your pediatrician/Physician medical emergency room/Physician primary care may ask, so it can be quite helpful to gather the information ahead of time to help figure out what’s causing the pain. • How long has the pain been present? Has it been days, weeks, or months? • How bad is the pain? Does your child cry? • Where is the pain? Around the belly button, or lower right belly? • How long does the pain last? Does anything seem to make it better or worse? • Any fever, vomiting, or diarrhea? • Does the pain wake her up at night or interfere with activity? • Does it happen only on preschool days, or a particular time of day? • How is her appetite? • Is it related to any specific food or drink such as milk products? Or is it better or worse after she eats? • Is she potty trained? Does the pain occur only when she needs to poop? • Does she poop every day? Is the stool hard or soft? Is it big or small? Is there any blood in the stool? • Any recent social or family stress or change in environment? • Any family history of stomach or intestinal diseases or issues? • Any recent travel or exposure to pets? Crying, Age 3 and Younger Crying related to normal development and behavior Hungry cries Upset cries Pain cries Crying related to a serious illness or injury Crying and shaken baby syndrome Crying related to medical conditions Are you concerned about your child's crying? Review health risks that may make any symptom more serious. How old ___ _____? Less than 3 months 3 months to 3 years 4 years or older Has your child had a head injury? Yes No Okay. Let's go to Head Injury, Age 3 and Younger Abdominal Pain, Age 11 and Younger Symptoms to watch for during home treatment Call your doctor if any of the following occur during home treatment: •Pain increases or localizes to one section of the abdomen. •Other symptoms develop, such as diarrhea, nausea, vomiting, or fever. •The belly feels hard or looks very swollen. •Symptoms become more severe or frequent. You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions: •Is your child vomiting? If so, describe how much, how often, and how long. •Does your child have a fever? •Has your child had an injury to the abdomen? •How long has your child had the pain? •What was your child doing when the pain started? •Has your child had similar episodes of abdominal pain before? What were these episodes like? How were they treated? •Is the pain constant, or does it come and go? •Is the pain localized to one area or generalized over the whole belly? •How severe is the pain? What has your child's activity level been? •Can your child describe the pain? Is the pain cramping, a steady ache, or sharp and burning? •What makes the pain better? What makes the pain worse? •Does your child have other symptoms, such as nausea, urinary problems, constipation, or diarrhea? •Has your child recently traveled outside of his or her native ______? •Has your child drunk any untreated well, stream, or lake water? •Does your child have any health risks? Does your child have pain or cramping in the belly? Review health risks that may make any symptom more serious. Yes No How old __ ____? Less than 3 months 3 months to 11 years 12 years or older Has your child had surgery on the chest or belly in the past 2 weeks? Okay. Let's go to Postoperative Problems Has your child swallowed or inhaled an object? Yes No Okay. Let's go to Swallowed or Inhaled Objects Does your child have symptoms of shock? Yes No Shock is a life-threatening condition that may occur quickly after a sudden illness or injury. Babies and young children often have several symptoms of shock. These include: •Passing out (losing consciousness). •Being very sleepy or hard to wake up. •Not responding when being touched or talked to. •Breathing much faster than usual. •Acting confused. The child may not know where he or she is. Where to get help •The emergency department of your nearest hospital Prevention Abdominal pain in children can often be prevented. •Abdominal pain in children is often caused by irregular bowel habits. Become familiar with your child's normal bowel patterns. Also, be aware of the size and consistency of your child's stools. This will help to determine whether constipation is a problem. For information on preventing constipation and establishing toilet training, see the topic Constipation, Age 11 and Younger. •Try to make sure your child has regular eating habits. Overeating is a common cause of abdominal discomfort. Have your child eat slowly and stop when he or she feels full. For more information, see the topic Healthy Eating for Children. •Swallowing air (aerophagia) can cause abdominal pain and a swollen abdomen. Your child may also have a lot of belching or flatus. Limit chewing gum and carbonated beverages to help prevent this. Many children swallow air when they are anxious or frightened. |
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Life threatening causes of abdominal pain •Generalised peritonitis with shock •Acute bowel obstruction •Ruptured abdominal aortic aneurysm •Acute mesenteric infarction •Toxic shock syndrome Patients with abdominal pain are common in the ED, but you need a strategy for quickly identifying patients who are at high risk for life-threatening causes of pain, and you need to order testing and consultation that improves the accuracy of your clinical assessment. • What are the 4 groups of patients with abdominal pain who are frequently misdiagnosed? • Why do elderly patients with appendicitis often have little or no abdominal pain? • In women of childbearing age, is there a realistic algorithm to distinguish gastroenteritis from appendicitis, ectopic pregnancy, and PID? • What role should prior abdominal surgeries have in assessing abdominal pain? • What are the 18 high-yield historical questions to ask patients who present with abdominal pain? • Fever, high WBC, low blood pressure, tachycardia: how reliable are these in pointing to a cause for abdominal pain? • Pain location, migration, tenderness, and guarding: what each one can (and can’t) tell you about what is going on. • When pelvic and testicular exams are must-dos. • What are the highest-yield lab tests? CBC? Lipase or amylase? CRP? • When x-ray is all you need, and when CT is a must. • Will opioids make diagnosis more difficult? |
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What are more serious cases of abdominal pain during pregnancy?
1. Miscarriage 2. Placental abruption 3. Preeclampsia 4. Ectopic pregnancy 5. Preterm labor 6. Urinary Tract Infection (UTI) 7. Appendicitis 8. Gallstones Many women have healthy pregnancies, but serious complications can develop that require immediate attention from your ob-gyn. Some red flags to watch out for include bleeding, severe pain, fever, and visual disturbances. Miscarriage When women experience abdominal pain in the first trimester, "you always have to be concerned about miscarriage," Dr. Duff says, because the unfortunate fact is that 15 to 20 percent of pregnancies end in miscarriage. Symptoms of miscarriage include bleeding and cramping that can be rhythmic or resemble menstrual cramps. Placental abruption Your placenta is the source of oxygen and nutrients for your baby. It usually implants high on the uterine wall and doesn't detach until after your baby is born. In rare cases (1 out of every 200 births), the placenta can separate from the uterine wall, a dangerous complication, which is most common in the third trimester. Dr. Duff describes the pain from a placental abruption as "severe, constant, progressively worsening lower abdomen pain." Your uterus may become rock hard (if you press on the abdomen, it won't indent) and you may also have dark, red blood that does not have clots. In some cases, a woman may go into labor when her placenta separates, in which case her ob-gyn will usually deliver the baby by emergency cesarean section. If the abruption is mild, a doctor may allow the pregnancy to continue or may induce labor and do a vaginal delivery. Women at risk for this condition include those who have a history of placental abruption, or who have high blood pressure, preeclampsia, and abdominal trauma. Preeclampsia According to the Preeclampsia Foundation of America, preeclampsia and other hypertensive disorders are experienced by 5 to 8 percent of all pregnant women. Preeclampsia can develop anytime after 20 weeks of pregnancy, which is one reason why your doctor checks your blood pressure at every appointment, and it is characterized by high blood pressure and protein in the urine. Because high blood pressure constricts the vessels in the uterus that supply the fetus with oxygen and nutrients, the baby's growth may be slowed. Preeclampsia also increases the risk of placental abruption, in which the placenta separates from the uterine wall before delivery. When preeclampsia is severe, it can be accompanied by pain in the upper right portion of your abdomen as well as nausea, headaches, swelling, and visual disturbances, such as flashing lights. It you suspect that you have preeclampsia, call your ob-gyn immediately. Ectopic pregnancy Ectopic or tubal pregnancies, in which the egg implants someplace other than the uterus, most often in the fallopian tube, occur in 1 in 50 pregnancies, according to the March of Dimes. In the unlikely event that you have an ectopic pregnancy, you may experience intense pain and bleeding between your 6th and 10th weeks of pregnancy, as the tube becomes distended. Women at increased risk for an ectopic pregnancy include those who have had an ectopic pregnancy in the past, or have had pelvic, abdominal, fallopian tube surgery, and those who have had endometriosis, a tubal ligation, an intrauterine device (IUD) in place at the time of conception, or a pelvic infection. An abnormally shaped uterus and the use of artificial reproductive techniques also seem to increase the risk. Ectopic pregnancies cannot continue and require immediate treatment. If you had a positive pregnancy test but have not yet had your pregnancy confirmed by a medical exam, and you experience abdominal pain, you should be evaluated immediately by your ob-gyn, says Linda Chambliss, M.D., chief of obstetrics at St. Joseph's Hospital and Medical Center in Phoenix. Your ob-gyn or midwife can perform an ultrasound to confirm whether the egg has implanted in the uterus. Preterm labor If you're experiencing regular contractions before you're 37 weeks pregnant, and you have a persistent backache, you could be having preterm labor. Now is not the time to wait it out--call your ob-gyn right away. The contractions may or may not be accompanied by leaking vaginal fluid or blood or a decrease in fetal movement. Even experienced pros on their third pregnancy may not be able to tell if contractions are just Braxton Hicks or true preterm labor, Dr. Chambliss says, so she asks her patients to call anytime they feel contractions. You may end up being sent home because it's a false alarm (Dr. Chambliss says that up to 30 percent of the women who show up in her triage unit are), but it's better to be safe than sorry, especially in this case. Urinary Tract Infection (UTI) Up to 10 percent of expectant moms will get a urinary tract infection (UTI) at some point during their pregnancy, according to the March of Dimes. Typical symptoms include a sudden urge to urinate, pain or burning with urination, and bloody urination--but some patients with a UTI also experience abdominal pain, Dr. Chambliss says. "The concern with UTIs during pregnancy is that they can progress to an infection in your kidneys that will increase your risk of preterm labor," she adds. That's one reason why your ob-gyn tests your urine every visit, to check for the signs of bacteria that can lead to a UTI. The good news is that if a UTI is caught early it should be easy to treat with antibiotics. Appendicitis Appendicitis can be difficult to diagnose in pregnancy, says Dr. Duff, because "as the uterus enlarges, the appendix pulls up and can get up near the belly button or liver. That atypical presentation gives us a curve ball." And because a diagnosis can be delayed, it's one of the reasons a woman is at greater risk of dying from appendicitis during pregnancy. Although the usual hallmark of appendicitis is pain in the lower right quadrant of your abdomen, when you're pregnant you may feel it higher up. Other symptoms include lack of appetite, nausea, and vomiting. Gallstones Stones in the gallbladder are more common in women, especially if they are overweight, over the age of 35, or have a history of stones. The pain from gallstones (also called cholecystitis) is severe and focused in the upper right quadrant of your abdomen. In some cases, the pain may also radiate around to your back and under your right shoulder blade. Here are further guidelines. |